STATE OF WASHINGTON



center26448400STATE OF WASHINGTONDEPARTMENT OF SOCIAL AND HEALTH SERVICESDevelopmental Disabilities Administration * P.O. Box 45310 * Olympia, WA 98504-5310DDA MANAGEMENT BULLETIND18-027 – ProcedureDecember 5, 2018Amended December 12, 2018Amended January 2, 2019TO:Regional AdministratorsDeputy Regional AdministratorsField Service AdministratorsSpecialistsSupervisorsCase Resource ManagersSocial Service SpecialistsFROM:Deborah Roberts, Deputy Assistant SecretaryDevelopmental Disabilities AdministrationSUBJECT:Integrated Settings and Heightened ScrutinyPurpose:To inform field services staff how to identify and report settings that do not meet integrated settings requirementsBackground:In 2014, the Centers for Medicare and Medicaid Services (CMS) implemented new integrated settings guidelines that require states to ensure that individuals receiving long-term services and supports (LTSS) through Home and Community-Based Services (HCBS) waivers, Community First Choice (CFC) State Plan programs, and Roads to Community Living (RCL) Project utilizing HCBS resources have full access to the benefits of community living. Under these CMS guidelines:The Developmental Disabilities Administration (DDA) and Aging and Long-Term Support Administration (ALTSA) assessed all HCBS settings and documented the assessments in the Statewide Transition Plan (STP). DDA and ALTSA recently received CMS approval of the STP.DDA has established procedures for ongoing review of questionable settings to ensure continued compliance with integrated settings requirements, as prescribed in the STP. What’s new, changed, or ClarifiedEffective Immediately, DDA staff must follow the procedures below when a setting is identified as potentially isolating or not in compliance with HCBS settings requirements.ACTION:Read the attachments describing Home and Community-Based settings.DDA staff must report to their supervisor any setting that appears to be isolating. The integrated settings concern may be revealed through staff observation, participant or staff reports, or other means.The CRM, Supervisor, appropriate specialist (Residential Quality Assurance Program Specialist (RPS), Performance and Quality Improvement Specialist (PQIS), Employment Specialist (ES), etc.) and other DDA staff, as appropriate, will discuss the issue and determine next steps. See attached CFR Compliance Quick Check.If, following the discussion, the team determines that follow up is needed, the case will be forwarded to the appropriate specialist. The specialist will contact the participant and provider and assess the setting using the attached residential or employment and day program HCBS Integrated Settings Survey. PQIS is responsible for reports involving Adult Family Homes. RPS is responsible for reports involving all other community residential settings. ES is responsible for reports involving employment and day programs. The ES will follow up with the appropriate county to ensure action is taken to bring the setting into compliance. The specialist must:For residential settings:Document summary of the visit and observations on the Residential Agency Tracking Database on DDA’s SharePoint. Select “Integrated Setting” as the “primary issue being addressed,” and complete the entry with relevant details.Scan completed HCBS Integrated Settings Survey form and email to the Residential QA Unit Manager, regardless of setting type.For employment and day program settings, scan completed HCBS Integrated Settings Survey form and email to the Residential QA Unit Manager, regardless of setting type.The Headquarters Residential Quality Assurance Team collaborates with the Case Resource Manager, RPS or PQI, the provider, and participant to develop a remediation plan to bring residential service settings into compliance.Headquarters must review the assessment of the setting; if the setting meets criteria for heightened scrutiny, headquarters must forward the assessment to CMS. Heightened scrutiny is a review process utilized by CMS to determine whether or not a setting has the qualities of a home and community-based setting.Related REFERENCES:Approved Statewide Transition Plan (pages 159-176) ATTACHMENTS:\s\s\s\sCONTACTS:Shaw Seaman, Residential Quality Assurance Unit ManagerSeamaSC@dshs.360-407-1565Bob Beckman, Waiver Requirements Program ManagerBeckmBC@dshs. 360-407-1555 ................
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